Military Injuries Research Articles

A communal intervention for military moral injury

The Moral Injury Group (MIG) at the Corporal Michael J. Crescenz (Philadelphia) VA Medical Center (CMCVAMC) is an example of collaborative care between chaplains and psychologists that engages religious, academic, and not-for-profit communities, as well as the media and other organizations external to the healthcare context. The intervention is primarily informed by a unique conceptualization: the moral injury (MI) of individual veterans is rooted in the unfair distribution of appropriate moral pain and best addressed through communal intervention that facilitates broader moral engagement and responsibility. MI is a public health issue that arises from the unfair distribution of appropriate moral pain and is sourced by the sedimentary layers of structural violence in US institutions related to war, and US war-culture. Preventing veteran suicide and promoting public health requires a larger social analysis and more broad-based, collective and collaborative understanding of, and response to, US war-culture, extending responsibility for MI care and prevention beyond individual veterans in health care institutions and clinical settings to US society.

Improving musculoskeletal injury surveillance methods in Special Operation Forces: A Delphi consensus study.

Musculoskeletal injury mitigation is a priority in military organisations to protect personnel health and sustain a capable workforce. Despite efforts to prevent injury, inconsistencies exist in the evidence used to support these activities. There are many known limitations in the injury surveillance data reported in previous Special Operation Forces (SOF) research. Such studies often lack accurate, reliable, and complete data to inform and evaluate injury prevention activities. This research aimed to achieve expert consensus on injury surveillance methods in SOF to enhance the quality of data that could be used to inform injury prevention in this population. A Delphi study was conducted with various military injury surveillance stakeholders to seek agreement on improving surveillance methods in SOF. Iterative questionnaires using close and open-ended questions were used to collect views about surveillance methods related to injury case definitions and identifying essential and optional data requirements. Consensus was predefined as 75% group agreement on an item. Sixteen participants completed two rounds of questionnaires required. Consensus was achieved for 17.9% (n = 7) of questions in the first-round and 77.5% (n = 38) of round two questions. Several challenges for surveillance were identified, including recording injury causation, SOF personnel's injury reporting behaviours influencing accurate data collection, and surveillance system infrastructure limitations. Key military injury surveillance stakeholders support the need for improved data collection to enhance the evidence that underpins injury prevention efforts. The consensus process has resulted in preliminary recommendations to support future SOF injury surveillance.

Perspectives on Primary Blast Injury of the Brain: Translational Insights Into Non-inertial Low-Intensity Blast Injury.

Most traumatic brain injuries (TBIs) during military deployment or training are clinically “mild” and frequently caused by non-impact blast exposures. Experimental models were developed to reproduce the biological consequences of high-intensity blasts causing moderate to severe brain injuries. However, the pathophysiological mechanisms of low-intensity blast (LIB)-induced neurological deficits have been understudied. This review provides perspectives on primary blast-induced mild TBI models and discusses translational aspects of LIB exposures as defined by standardized physical parameters including overpressure, impulse, and shock wave velocity. Our mouse LIB-exposure model, which reproduces deployment-related scenarios of open-field blast (OFB), caused neurobehavioral changes, including reduced exploratory activities, elevated anxiety-like levels, impaired nesting behavior, and compromised spatial reference learning and memory. These functional impairments associate with subcellular and ultrastructural neuropathological changes, such as myelinated axonal damage, synaptic alterations, and mitochondrial abnormalities occurring in the absence of gross- or cellular damage. Biochemically, we observed dysfunctional mitochondrial pathways that led to elevated oxidative stress, impaired fission-fusion dynamics, diminished mitophagy, decreased oxidative phosphorylation, and compensated cell respiration-relevant enzyme activity. LIB also induced increased levels of total tau, phosphorylated tau, and amyloid β peptide, suggesting initiation of signaling cascades leading to neurodegeneration. We also compare translational aspects of OFB findings to alternative blast injury models. By scoping relevant recent research findings, we provide recommendations for future preclinical studies to better reflect military-operational and clinical realities. Overall, better alignment of preclinical models with clinical observations and experience related to military injuries will facilitate development of more precise diagnosis, clinical evaluation, treatment, and rehabilitation.

Correlations Between the Neurobehavioral Symptom Inventory and Other Commonly Used Questionnaires for Traumatic Brain Injury.

To evaluate the correlations between the Neurobehavioral Symptom Inventory (NSI) and other questionnaires commonly administered within military traumatic brain injury clinics. Military outpatient traumatic brain injury clinics. In total, 15,428 active duty service members who completed 24,162 NSI questionnaires between March 2009 and May 2020. Observational retrospective analysis of questionnaires collected as part of standard clinical care. NSI, Post-Traumatic Stress Disorder Checklist for DSM-5 and Military Version, Patient Health Questionnaire (PHQ), Generalized Anxiety Disorder, Headache Impact Test (HIT-6), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), Activities-Specific Balance Confidence Scale (ABC), Dizziness Handicap Inventory (DHI), Alcohol Use Disorders Identification Test (AUDIT), and the World Health Organization Quality of Life Instrument-Abbreviated Version. Only questionnaires completed on the same date as the NSI were examined. The total NSI score was moderately to strongly correlated with all questionnaires except for the AUDIT. The strongest correlation was between the NSI Affective Score and the PHQ9 (r = 0.86). The NSI Vestibular Score was moderately correlated with the ABC (r = -0.55) and strongly correlated with the DHI (r = 0.77). At the item level, the HIT-6 showed strong correlation with NSI headache (r = 0.80), the ISI was strongly correlated with NSI difficulty sleeping (r = 0.63), and the ESS was moderately correlated with NSI fatigue (r = 0.39). Clinicians and healthcare administrators can use the correlations reported in this study to determine if questionnaires add incremental value for their clinic as well as to make more informed decisions regarding which questionnaires to administer.

Laminin-111-Enriched Fibrin Hydrogels Enhance Functional Muscle Regeneration Following Trauma.

Volumetric muscle loss (VML) is the surgical or traumatic loss of skeletal muscle, which can cause loss of limb function or permanent disability. VML injuries overwhelms the endogenous regenerative capacity of skeletal muscle and results in poor functional healing outcomes. Currently, there are no approved tissue engineering treatments for VML injuries. In this study, fibrin hydrogels enriched with laminin-111 (LM-111; 50-450 μg/mL) were used for the treatment of VML of the tibialis anterior in a rat model. Treatment with fibrin hydrogel containing 450 μg/mL of LM-111 (FBN450) improved muscle regeneration following VML injury. FBN450 hydrogel treatment increased the relative proportion of contractile to fibrotic tissue as indicated by the myosin: collagen ratio on day 28 post-VML injury. FBN450 hydrogels also enhanced myogenic protein expression and increased the quantity of small to medium size myofibers (500-2000 μm2) as well as innervated myofibers. Improved contractile tissue deposition due to FBN450 hydrogel treatment resulted in a significant improvement (∼60%) in torque production at day 28 postinjury. Taken together, these results suggest that the acellular FBN450 hydrogels provide a promising therapeutic strategy for VML that is worthy of further investigation. Impact statement Muscle trauma accounts for 50-70% of total military injuries and complications involving muscle result in ∼80% of delayed amputations. The lack of a clinical standard of care for volumetric muscle loss (VML) injuries presents an opportunity to develop novel regenerative therapies and improve healing outcomes. Laminin-111-enriched fibrin hydrogel may provide a promising therapy for VML that is worthy of further investigation. The acellular nature of these hydrogels will allow for easy off the shelf access to critically injured patients and fewer regulatory hurdles during commercialization.

Pathomorphological markers of blast-induced brain injury

Background. Recently, interest in blast-induced brain injuries has been increasing due to military events and the use of explosive devices in eastern Ukraine. Considering the diagnostic uncertainty regarding the specific signs of brain injury after the distant action of an blast shock wave, the danger of prognostic consequences, the increase of the cases of explosive injury number, we consider that selected for study topic is relevant. Objective. Purpose – determination of pathomorphological changes of the brain after the action of the blast wave. Methods. To solving this purpose, a retrospective analysis of 280 cases of fatal military blast injuries was conducted. We selected 6 cases for microscopic examination of the brain. For histological examination, samples were taken from different parts of the brain. Results. Analysis of 280 deaths due to explosive trauma showed that 58.9% of the dead (165) had a traumatic brain injury, and in 131 cases it was accompanied by fractures of the bones of the vault and the base of the skull. Isolated traumatic brain injury was detected in only 33 cases (11.8%). Age distribution analysis of the dead people showed that 67.5% of the dead were between the ages of 21 and 40. Histopathological analysis of brain samples from the dead allowed to identify the characteristic signs of blast-induced brain injury in the form of diffuse formation of perivascular microhemorrhages with partial or complete separation of the vascular wall from the neuropil. Conclusion. The complex of microscopic signs in the brain, namely, the separation of vascular wall from neuroglia with the formation of perivascular space, fragmentation of these vessels walls, erythrocytes hemolysis, hemorrhage in the newly formed perivascular spaces, are direct evidences of the blast wave action.

Professor Pavel Efremovich Tikhomirov. On the occasion of 125th anniversary of the birth

In the article, data on creative activity and personality of the Professor in ophthalmology Pavel Efremovich Tikhomirov are presented. Under the guidance of Academician M.I. Averbakh in the Helmholtz Moscow research institute of eye diseases, Pavel Efremovich raised through the ranks from a medical extern to Senior research fellow, Professor, Vice-Director of the institute. From 1945 to the end of his life (1964), he was the Head of the Ophthalmology chair of the Leningrad Medical Institute of Sanitation and Hygiene (currently the North-Western State Medical University named after I.I. Mechnikov). P.E. Tikhomirov took part in two wars: in 19191922 served in the Red Army in the position of a regimental doctor, during the Great Patriotic War, he was a Head ophthalmologist of a Hospital Administration of the Ministry of Health of the Russian Federation (he organized and headed the military hospital department in Moscow, took multiple missions to evacuation hospitals of the country).
 Main scientific activities of P.E. Tikhomirov: problems of the military ocular injuries, diagnosis and treatment of lacrimal system diseases, glaucoma, pre-glaucoma, and ocular tuberculosis. His writings include three monographies, two sections of the multi-volume edition on eye diseases, more than 100 scientific articles, a compendium of scientific articles Glaucoma (1960).
 Pavel Efremovich was an experienced organizer and a good psychologist. He began teaching Ophthalmology in 1933 in two Moscow institutes of higher education. During 19451964, being the Head of the Ophthalmology chair of the Leningrad Medical Institute of Sanitation and Hygiene, excellent teacher and lecturer, very good clinician, Professor P.E. Tikhomirov prepared hundreds of ophthalmologists, 6 candidates of medical sciences, was a consulting specialist of three doctorate theses.
 Real professional and clinician, outstanding ophthalmic surgeon, Professor P.E. Tikhomirov during 45 years of his medical career recovered the sight of many thousands of patients and was widely well-known not only in Leningrad, but in the whole country.

Elevated Kinesiophobia Is Associated With Reduced Recovery From Lower Extremity Musculoskeletal Injuries in Military and Civilian Cohorts.

The purpose of this study was to examine associations between level of kinesiophobia and improvement in physical function during recovery from lower extremity injury. A total 430 adults (mean [SD]: age = 27.3 [6.4] years; sex = 70.5% men; body mass index = 27.6 [5.2] kg/m2) were included in the analyses. Using the Patient-Reported Outcomes Measurement Information System, physical function was evaluated in parallel with treatment from a physical therapist at the initial visit and every 3weeks until final visit or up to 6months. A Tampa Scale of Kinesiophobia (TSK-17) score of >41 indicated elevated TSK. Four TSK groups were identified: (1) TSK score improved from >41 at initial visit to <41 by final visit (TSK_I), (2) TSK score was <41 at initial and final visits (TSK-), (3) TSK score was >41 at initial and final visits (TSK+), and (4) TSK score worsened from <41 at initial visit to ≥41 by final visit (TSK_W). Linear mixed effects models were used to examine differences between groups in improved physical function over time, with adjustment for depression and self-efficacy. Groups with elevated kinesiophobia at the final visit had smaller positive improvements in physical function (mean change [95% CI]: TSK+ = 7.1 [4.8-9.4]; TSK_W: 6.0 [2.6-9.4]) compared with groups without elevated kinesiophobia at the final visit (TSK_I = 9.8 [6.4-13.3]; TSK- = 9.7 [8.1-11.3]) by 12 weeks. Elevated kinesiophobia that persists or develops over the course of care is associated with less improvement in physical function within military and civilian cohorts. The findings of this prospective longitudinal study support the need to assess for elevated kinesiophobia throughout the course of care because of its association with decreased improvement in physical function. To help improve your physical function, your physical therapist can monitor the interaction between fear of movement and your clinical outcomes over the course of treatment.

Retrospective study of Parajump injuries in Indian Armed Forces

Introduction: A number of studies on military and civil parachuting injuries have been published in the past. Most of the studies place the incidence of parachuting injuries to vary between 0.22% and 0.89%. The profile of injuries sustained during jumps by Indian paratroopers from Paratrooper Training School (PTS), Agra, between 2013 and 2019 was analyzed. Material and Methods: A retrospective analysis of Indian military parachuting injuries was done to assess injury patterns from the records of static line and combat free fall jumps, available at the PTS. The data pertaining to 270 injuries sustained from 256 jumps were analyzed in terms of number of jumps by each paratrooper, type of course/ mission, age, time of the of jump (day/ night), type of parachute used, wind speed at the time of drop, terrain on which the paratrooper landed, the location / part of body injured, the diagnosis, and finally the possible modality of injury using descriptive statistics. Results: The incidence of injuries ascertained from the records varied from 0.054% to 0.10% with a mean incidence of 0.083% from 306,986 jumps recorded over 7 years. Most injuries were related to refresher jumps and static line jumps. There were three fatalities recorded in this period, all due to failure of main and standby parachutes. Most of the injuries were sustained at the time of landing (218, 86.17%). Lower limb injuries accounted for maximum injuries (109, 40.37%), followed by truncal injuries 95 (35.19%) and upper limb injuries 33 (12.22%). Conclusion: The study brings out an interesting aspect of significantly less military parachuting injuries seen in the present study vis-à-vis reported in literature. A high degree of physical fitness and rigorous training are probably responsible for this low incidence. Increasing the duration of refresher training and physical conditioning may further reduce the occurrence of injuries. A cost-efficacy analysis of the same may be done before effecting changes in the training programme.

Military thoracic gunshot wounds: A systematic review

Abstract A systematic review of the literature was carried out using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method to investigate the frequency of military thoracic gunshot wounds (GSWs) and deaths in combat theatres since World War Two (WW2). An electronic database search of World of Science, Scopus, Science Direct, PubMed and Microsoft Academic was conducted using the keywords ‘combat, casualties, thorax, gunshot, and military’ to identify peer-reviewed journals and conference papers on the topic. Twenty-three sources relevant to this review were identified and covered multiple theatres of operation. While there is a downward trend in the frequency of thoracic GSWs and fatalities likely due to the improvement of body armour, the improvement in medical treatment and increased frequency of improvised explosive devices (IEDs), the review shows that the advancement has not removed the likelihood of thoracic GSWs, which still accounted for approximately 15% of all thoracic injuries in the most recent combat theatres. The systematic review identifies that GSWs of the thorax continue to be a risk in military theatres and therefore, medical personnel should be aware of the frequency and severity of thoracic GSWs and should be prepared to treat these life-threatening injuries, as timely intervention is essential.

Zonulotomia Stock (Klin. Mon. f. Augenheil., 1918)

In 2 cases of military eye injuries, where the opaque lens was spliced with a cord with the marginal scar of the cornea and the iris, Stock (Klin. Mon. f. Augenheil., 1918) performed a small operation, which, in his opinion, in such cases is preferable to iridectomy and discision lens.

On the Shoulders of Giants: A Tribute to Professor Norman Rich's Work on Graft Thrombosis

Recent papers such as “Outcomes of arterial graft for the reconstruction of military lower extremity arterial injuries” by Dr. Laverty et al. have reminded us of the strong military vascular surgery foundation established by Retired U.S. Army Colonel Norman M. Rich, MD, FACS, DMCC, MC.1 Col Rich's medical career began at Stanford University. He graduated from surgical residency at Letterman General Hospital. Directly following his graduation, he was assigned to the second Mobile Army Surgical Hospital as chief of surgery during a tour of duty in An Khe, Vietnam from 1965 to 1966.

The Military Injuries: Understanding Post-Traumatic Epilepsy Study: Understanding Relationships among Lifetime Traumatic Brain Injury History, Epilepsy, and Quality of Life.

Understanding risk for epilepsy among persons who sustain a mild (mTBI) traumatic brain injury (TBI) is crucial for effective intervention and prevention. However, mTBI is frequently undocumented or poorly documented in health records. Further, health records are non-continuous, such as when persons move through health systems (e.g., from Department of Defense to Veterans Affairs [VA] or between jobs in the civilian sector), making population-based assessments of this relationship challenging. Here, we introduce the MINUTE (Military INjuries-Understanding post-Traumatic Epilepsy) study, which integrates data from the Veterans Health Administration with self-report survey data for post-9/11 veterans (n = 2603) with histories of TBI, epilepsy and controls without a history of TBI or epilepsy. This article describes the MINUTE study design, implementation, hypotheses, and initial results across four groups of interest for neurotrauma: 1) control; 2) epilepsy; 3) TBI; and 4) post-traumatic epilepsy (PTE). Using combined survey and health record data, we test hypotheses examining lifetime history of TBI and the differential impacts of TBI, epilepsy, and PTE on quality of life. The MINUTE study revealed high rates of undocumented lifetime TBIs among veterans with epilepsy who had no evidence of TBI in VA medical records. Further, worse physical functioning and health-related quality of life were found for persons with epilepsy + TBI compared to those with either epilepsy or TBI alone. This effect was not fully explained by TBI severity. These insights provide valuable opportunities to optimize the resilience, delivery of health services, and community reintegration of veterans with TBI and complex comorbidity.

The Occupational Military Neuromusculoskeletal Injury Matrix.

Neuromusculoskeletal injuries (NMSKIs) are the primary cause of ambulatory visits, lost duty days, and disability discharges in the U.S. Military. Methods for accurately grouping injury diagnoses are required to allow for surveillance and research identifying risk factors and prevention strategies. The CDC method of grouping these diagnoses includes only the S and T codes (Injury, poisoning, and certain other consequences of external causes) from the ICD-10-CM. However, this does not include the majority of the NMSKI depleting soldier readiness; the M (Disease of the musculoskeletal system and connective tissue) and G (Diseases of the nervous system) codes should be included as these also contain injuries. The goal was to develop a new matrix that would comprehensively capture all NMSKIs experienced by military personnel. This paper details the development of the Occupational Military Neuromusculoskeletal Injury (OMNI) Matrix and characterizes the number and rates of active duty U.S. Army injuries as measured by the OMNI compared to other matrices. A team of researchers including physical therapists, physician assistants, occupational therapists, physicians, and epidemiologists developed the OMNI. The OMNI utilizes the commonly accepted injury definition inclusive of any anatomical complaint resulting in pain or dysfunction and categorizes injuries from the G, M, S, and T codes. The OMNI follows the CDC's matrix structure with three body region levels, each becoming more specific, and adds two levels called Description of the Injury. Additionally, the OMNI categorizes injuries as Injury Type (Acute, Overuse, Either, or Not Applicable), NMSKI-Type (NMSKI, NMSKI that could be caused by occupational/training tasks, and not an NMSKI), and a miscellaneous category that demarks injuries as Superficial, Blood Vessels, and/or Internal Organs. The different grouping methods in the OMNI provide standardization for many possible injury case definitions. The OMNI allows these injury categories to be included/excluded in a standardized fashion to meet the researchers' scientific questions. To enumerate the number of NMSKI that would be captured by the available matrices, the OMNI, the CDC's matrix, and the U.S. Army Public Health Center's (APHC) Taxonomy of Injuries were applied to active duty Army outpatient population data and all incident NMSKI diagnostic codes entered in electronic medical provider encounters for calendar years 2017 and 2018. Using the OMNI resulted in the capture of over 800,000 more injuries than the CDC's matrix and over 200,000 more than the APHC Taxonomy. The NMSKI rate utilizing the OMNI was 193 per 100 soldier-years in 2017 (892,780 NMSKI) compared to 23 per 100 soldier-years for the CDC's matrix, and 141 per 100 soldier-years for the APHC Taxonomy. The OMNI provides an updated standardized method of assessing injuries, particularly in occupational military injury research, that can be utilized for Military Performance Division of injury across many countries and still allow for replication of methods and comparison of results. Additionally, the OMNI has the capacity to capture a greater burden of injury beyond what is captured by other available matrices.

The Impacts of ICD-10-CM on U.S. Army Injury Surveillance

Injuries are the leading cause of medical encounters and lost work days in the U.S. Army, affecting more than half of active-duty soldiers annually. Historically, Army injury surveillance has captured both acute traumatic and cumulative microtraumatic overuse injuries. This article describes how the transition from the ICD-9-CM to ICD-10-CM impacted U.S. military injury surveillance by comparing injury rates and distributions under both systems. Mapping ICD-9-CM codes to the expanded ICD-10-CM codes is not a straightforward endeavor; therefore, the Army Public Health Center incorporated ICD-10-CM codes into a comprehensive, systematic approach to taxonomically categorize injuries. This taxonomic methodology was applied to Army injuries under ICD-10-CM (2016-2019) and compared with the ICD-9-CM Army injury surveillance definitions (2012-2015). Soldier injury rates appeared to increase when surveillance with ICD-10-CM began. Soldiers experienced 1,276 incident injury medical encounters per 1,000 person-years in 2015 (ICD-9-CM), compared with 1,804 injuries per 1,000 in 2016 (ICD-10-CM), a 41% increase. Importantly, the distribution of injuries also shifted, such that the average cumulative microtraumatic injury rate increased by 42% during 2016-2019 (ICD-10-CM) compared with the 2012-2015 average (ICD-9-CM), whereas acute traumatic injuries only increased by 17%. The enhanced descriptions provided by ICD-10-CM codes and the applied taxonomic categorizations have improved precision in Army injury surveillance. Data unequivocally show that most injuries in this physically active population are cumulative microtraumatic injuries. The taxonomic methodology can be extended to injury surveillance in other populations and may allow a more efficient transition to ICD-11-CM.

Changes in intolerance of uncertainty over the course of treatment predict posttraumatic stress disorder symptoms in an inpatient sample.

Intolerance of uncertainty (IU) is the inability to tolerate distress that arises in response to the absence of important information. The level of IU has been investigated across various psychological disorders; however, few studies have examined IU in trauma‐affected samples. We aimed to investigate the relationship between IU and posttraumatic stress disorder (PTSD) across the course of treatment. Participants (n = 106) had a diagnosis of PTSD and were from first responder, military, and occupational injury backgrounds. Participants completed self‐report questionnaires pre‐ and post‐engagement in an inpatient group trauma‐informed psychoeducation and skills (TIPS) intervention. Regression analyses indicated that decreases in overall and inhibitory IU were associated with decreases in PTSD severity overall and at the symptom cluster level. However, prospective IU was only associated with changes in the re‐experiencing, avoidance, and arousal PTSD symptom clusters. Our findings are congruent with the nascent literature indicating that IU may be a maintaining factor for PTSD, suggesting clinical relevance for attendance to IU within the course of treatment.

A multi-registry analysis of military and civilian penetrating cervical carotid artery injury.

Penetrating cervical carotid artery injury is an uncommon but high-stake scenario associated with stroke and death. The objective of this study was to characterize and compare penetrating carotid injury in the military and civilian setting, as well as provide considerations for management. Cohorts with penetrating cervical carotid artery injury from the Department of Defense Trauma Registry (2002-2015) and the American Association for the Surgery of Trauma Prospective Observation Vascular Injury Treatment Registry (2012-2018) were analyzed. A least absolute shrinkage and selection operator multivariate analysis using random forest-based imputation was performed to identify risk factors affecting stroke and mortality. There were a total of 157 patients included in the study, of which 56 (35.7%) were military and 101 (64.3%) were civilian. The military cohort was more likely to have been managed with open surgery (87.5% vs. 44.6%, p < 0.001) and to have had any procedure to restore or maintain flow to the brain (71.4% vs. 35.6%, p < 0.001), while the civilian cohort was more likely to undergo nonoperative management (45.5% vs. 12.5%, p < 0.001). Stroke rate was higher within the military cohort (41.1% vs. 13.9%, p < 0.001); however, mortality did not differ between the groups (12.5% vs. 17.8%, p = 0.52). On multivariate analysis, predictors for stroke were presence of a battle injury (log odds, 2.1; p < 0.001) and internal or common carotid artery ligation (log odds 1.5, p = 0.009). For mortality outcome, protective factors included a high Glasgow Coma Scale on admission (log odds, -0.21 per point; p < 0.001). Increased admission Injury Severity Score was a predictor of mortality (log odds, 0.05 per point; p = 0.005). The stroke rate was higher in the military cohort, possibly reflecting complexity of injury; however, there was no difference in mortality between military and civilian patients. For significant injuries, concerted efforts should be made at carotid reconstruction to reduce the occurrence of stroke. Retrospective cohort analysis, level III.

The Map of Need: identifying and predicting the spatial distribution of financial hardship in Scotland’s veteran community

IntroductionDuring military service, many household costs for both married and single service personnel are subsidised, and transition can leave veterans unprepared for the financial demands of civilian life. Armed Forces...

M3: The military medicine module: A focussed competency-based program

BackgroundMilitary medicine is a unique and specific field for the armed forces doctors providing skill-based training on military specific injuries and diseases arising due to the unique occupational conditions. The current study retrospectively studied the planning and implementation of the military medicine module which was carried out with the aim of imparting the requisite skills to military doctors. MethodsThe study was a qualitative research, carried over two years, 2017-2019. The study population included two batches of recently graduated medical doctors about to be commissioned . The methodology included needs assessment and gap analysis which was carried out by consulting experts from the tri services. Feedback was taken by medical education experts from both the batches using surveys, and modifications were done after brainstorming with experts keeping feedback in mind. ResultsThere was an improvement in the rating scores and an improved performance by participants was seen in the competencies. ConclusionIn conclusion the module was developed and implemented keeping in mind the important skills that military physicians need to learn through training as these are not been taught in any educational syllabus. To achieve such skills and capabilities, gap analysis is essential and programs should be implemented keeping scope for modification depending on the feedback after brainstorming. Feedback remains important in development of such modules and hence should be collected anonymously.

Coordinating Global Multi-Site Studies of Military-Relevant Traumatic Brain Injury: Opportunities, Challenges, and Harmonization Guidelines.

Traumatic brain injury (TBI) is common among military personnel and the civilian population and is often followed by a heterogeneous array of clinical, cognitive, behavioral, mood, and neuroimaging changes. Unlike many neurological disorders that have a characteristic abnormal central neurologic area(s) of abnormality pathognomonic to the disorder, a sufficient head impact may cause focal, multifocal, diffuse or combination of injury to the brain. This inconsistent presentation makes it difficult to establish or validate biological and imaging markers that could help improve diagnostic and prognostic accuracy in this patient population. The purpose of this manuscript is to describe both the challenges and opportunities when conducting military-relevant TBI research and introduce the Enhancing NeuroImaging Genetics through Meta-Analysis (ENIGMA) Military Brain Injury working group. ENIGMA is a worldwide consortium focused on improving replicability and analytical power through data sharing and collaboration. In this paper, we discuss challenges affecting efforts to aggregate data in this patient group. In addition, we highlight how "big data" approaches might be used to understand better the role that each of these variables might play in the imaging and functional phenotypes of TBI in Service member and Veteran populations, and how data may be used to examine important military specific issues such as return to duty, the late effects of combat-related injury, and alteration of the natural aging processes.